Abstinence vs. 'controlled drinking'

Firstly I chose the title of this blog in order to highlight what I think is a significant challenge to anyone working in the field of alcohol misuse (or other substances for that matter)....because the two ideals are not entirely opposed and because neither is right nor wrong, better or worse...its not about versus.

The issue / subject of being abstinent from alcohol or aiming for a reduction and ongoing 'controlled' drinking (ideally within lower risk guidelines) comes up time and time again with both patients (the people I speak to and support) and staff (those I provide training to).  It is a debate that is continually being held, a debate which can never be entirely resolved, but also one which can be damaging in terms of whether patients achieve their goals or how well staff are able to promote and reinforce lifestyle change.

On the one hand, many people believe that abstinence (preferably lifelong) is the correct goal to aim at when alcohol has become a significant or prolonged problem in someone's life.  'Many people' may mean those who have drunk alcohol problematically, the carers, relatives, friends of someone who has struggled to control their alcohol use and also people employed in roles where they care for such individuals.

On the other hand there is a similarly sized group of people who believe that controlled drinking is an entirely valid path to choose when alcohol has been or become a problem.

And in my line of work I would say I meet about 60% of people who would choose controlled drinking and about 40% who would choose at least a lengthy period of abstinence from alcohol if not lifelong.

Neither group of patients are right or wrong in their opinion on what their future plan around their alcohol use should be, but unfortunately all too often this area is hijacked by stereotypical viewpoints.  I have spoken to many people (patients and staff) over the years who feel so strongly about either of the two ideals that they have become closed off from considering that the one they don't believe in is valid; "all alcoholics should be abstinent, they cannot have 1 drink because it is bound to lead to another" ... "everyone can control their drinking and abstinence is not realistic - we don't live in a world where people don't drink."

I say unfortunate for a number of reasons; firstly people's goals are personal or should be if they are likely to be achieved - it is not for other people to judge, secondly neither school of thought is entirely right or wrong - many people who have drunk problematically will achieve control over their alcohol use and continue to drink occasionally and in a non-problematic way, on the other hand others fail to do this in spite of numerous attempts and eventually come to the conclusion that abstinence is the more appropriate goal.

When people become so caught up in one argument or the other, that is where the problems begin because they can either repeatedly fail to make realistic or personal goals, or if they are someone who's role it is to support a person may attempt to impose their ideals on the individual in front of them.  A good example of this which occurs fairly regularly is in terms of staff who may judge people who say they don't want to give up alcohol as being "in denial."  They subsequently struggle to provide positive messages to the patients or to encourage them to develop realistic goals.

I believe that my role is to assist the individuals I'm working with to firstly decide that action needs to be taken of course, but in terms of developing a longer term plan around alcohol use, for them to carefully and rationally weigh up the pros and cons of either path.  For them to develop so-called SMART goals, not unrealistic, inappropriate ones that are more likely to fail than be a success.

It is not for me to provide them with goals in the same way of course that is is for ME to decide my own path and my own set of goals in life.  I will be influenced and probably supported at times by others but in the end the goals have to be mine.

However I do believe very strongly that where appropriate it is my role to challenge people to analyse their plans in order that they develop a strategy / set of ambitions which are not only realistic but 100% in line with them as a person and what they genuinely believe is the 'right' thing to do.

I have seen many people over the years who have become completely obsessed with notions of abstinence from alcohol; believing that they cannot control their alcohol use, that "1 drink is bound to lead to another" and that the only goal they can set themselves is a one of a life without alcohol in any form or in any circumstance.  Sometimes this is tragic to see; where all the evidence is that a person has no particular reason to aim at lifelong abstinence but does so mainly because of pressure from family or because that is what they perceive those with 'an alcohol problem' must or should do; their is no other option for them.

Equally I have witnessed the continued failed efforts of people attempting to 'control' their alcohol use when all the evidence suggests that at least in the near term this is not going to be possible; their goal is neither sensible nor realistic...and similar to the paragraph above will typically be based on society's views rather than personal ones: "I want to be able to enjoy a drink like everyone else."

My point is not that people who choose abstinence have got it wrong, or that those who aim for controlled drinking have got it right....more that people need to make goals which are as personal as possible.  Goals that are based as far as possible on what that person believes will be realistic to achieve.  Goals which are influenced as little as possible by stereotypical perspectives / societal or media portrayals / messages.

We live in a society (in the UK at least) where around 90% of adults drink alcohol on at least an occasional basis.  Alcohol is deeply rooted in huge sections of our life and our society.  No matter how inappropriate it is, the reality is that people who are abstinent are frequently regarded as having "something wrong"" with them.  This demands that anyone considering long term abstinence must think very carefully about their reasons for pursuing it the first place and to rely as little as possible on what others think they should do.

Similarly although the vast majority of adults in the UK drink alcohol, that in itself should not be the main reason for someone wanting to pursue controlled drinking.

I think that both schools of thought have equal merit and that neither should be dismissed.

I believe that anyone working in this field must be open to either path being a potential option for those we provide support to, but that it must also be a part of our role to probe into the reasons behind someone's goals in order that they are become as robust as possible.